DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20190354

Which is a better marker for overweight: waist height ratio or waist circumference?

Sanam Anwar, Bushra Aleem, Hajir H. Rashid, Ghadeer J. Moslhey

Abstract


Background: The global prevalence of obesity has been increasing. Body mass index, waist circumference and waist height ratio have been widely used for nutritional assessment. Waist height ratio has the advantage of taking into account abdominal obesity as well as height associated with body fat accumulation or distribution. The objective of this study was to suggest cut off points for waist circumference and waist height ratio to identify overweight in Omani adults.

Methods: Weight, height, waist circumference and waist height ratio were measured for all participants. Pearson’s correlation was used to determine correlation of BMI with waist circumference and waist height ratio. ROC curve was used to identify AUC and specific cut off point for anthropometric indicators.

Results: The largest proportion of overweight was picked up by waist height ratio across both the genders. Correlation of BMI with waist height ratio was stronger (r=0.699) than correlation with waist circumference (r=0.589) for both the genders. Maximum AUC was for waist height ratio in males (AUC=0.833, 95% CI=0.791-0.875). The specific cut off point for waist circumference in males and females was 89.5cm and 87.6cm respectively. The specific cut off point for waist height ratio in males and females was 0.53 and 0.57 respectively.

Conclusions: Maximum participants were found overweight by waist height ratio followed by waist circumference and the least by BMI. The higher cut off points should be used in this population for identifying overweight people.

Keywords


Area under curve, Cutoff values, Overweight, Waist circumference, Waist height ratio

Full Text:

PDF

References


Ogden CL, Flegal KM, Carroll M, Johnson, C.L. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288:1728-32.

Al Riyami A, Elaty MA, Morsi M, Al Kharusi H, Al Shukaily W, Jaju S. Oman world health survey: part 1-methodology, sociodemographic profile and epidemiology of non-communicable diseases in oman. Oman Medical J. 2012 Sep 1;27(5):425-43.

Willett W. Nutritional epidemiology. 3rd ed. Oxford: Oxford University Press; 2012.

Satoh H, Kishi R, Tsutsui H. Body mass index can similarly predict the presence of multiple cardiovascular risk factors in middle-aged Japanese subjects as waist circumference. Intern Med. 2010;49:977-82.

Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: A meta-analysis. Obes Rev. 2016;17:1258-75.

Blüher S, Molz E, Wiegand S, Otto KP, Sergeyev E, Tuschy S, et al. Adiposity patients registry initiative and the German competence net obesity. body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development. J Clin Endocrinol Meta. 2013 Aug 1;98(8):3384-93.

Mokha JS, Srinivasan SR, DasMahapatra P, Fernandez C, Chen W, Xu J, Berenson GS. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: The Bogalusa Heart Study. BMC Pediatr. 2010;10(1).

Schneider HJ, Klotsche J, Silber S, Stalla GK. Measuring abdominal obesity: Effects of height on distribution of cardiometabolic risk factors risk using waist circumference and waist-to-height ratio. Diabetes Care. 2011;34(7).

Tatsumi Y, Watnabe M, Kokubo Y, Nishimura K, Higashiyama A, Okamura T, et al. Effect of age on the association between waist-to-height ratio and incidence of cardiovascular disease: the suita study. J Epidemiol. 2013;23:351-9.

Hsieh SD, Yoshinaga H. Do people with similar waist circumference share similar health risks irrespective of height? Tohoku J. Exp Med. 1999;188:55-60.

Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int. J. Food Sci. Nutr. 2005;56:303-7.

Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: Systematic review and meta-analysis. Obes Rev. 2012;13:275-86.

Geneva: World Health Organization. Waist circumference and waist-hip ratio. report of who expert consultation, 2008. 2011. Available at: https://www.who.int/nutrition/publications/obesity/WHO_report_waistcircumference_and_waisthip_ratio/en/.

Yanga F, Lei SF, Chena XD. Receiver-operating characteristic analyses of body mass index, waist circumference and waist to-hip ratio for obesity: Screening in young adults in central south of China. Clin Nut. 2006;25:1030-9.

Ashwell, M. The Ashwell shape chart-a public health approach to the metabolic risks of obesity. Int. J. Obes. 1998;22(213).

Sung R, Yu C, Choi K, McManus A et al. Waist circumference and body mass index in Chinese children: Cutoff values for predicting cardiovascular risk factors. Int J Obes. 2007;31:550-8.

Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23:247-69.

Greiner M, Pfeiffer D, Smith R. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med. 2000;45:23-41.

Obuchowski NA, Lieber ML. Confidence intervals for the receiver operating characteristic area in studies with small samples. Acad Radiol. 1998;5:561-71.

Kurpad SS, Tandon H, Srinivasan K, Kurpad SS, Tandon H, Srinivasan K. Waist circumference correlates better with body mass index than waist-to-hip ratio in Asian Indians. Natl Med J India. 2002;16:189-92.

Corrêa MM, Tomasi E, Thumé E, Oliveira ER, Facchini LA. Waist-to-height ratio as an anthropometric marker of overweight in elderly Brazilians. Cadernos de saude publica. 2017;33(5).

Neovius M, Linné Y, Rossner S. BMI, waist-circumference and waist-hip-ratio as diagnostic tests for fatness in adolescents. Int J Obes Lond. 2005;29:163-9.

Marjani A. Waist circumference, body mass index, hip circumference and waist-to-hip ratio in type 2 diabetes patients in Gorgan, Iran. J Clindiag Res. 2011;5:201-5.

Ashwell M. Charts based on body mass index and waist-to-height ratio to assess the health risks of obesity: a review. Open Obes J. 2011;3:78-84.

Xu F, Wang YF, Lu L, Liang Y, Wang Z, Hong X, et al. Comparison of anthropometric indices of obesity in predicting subsequent risk of hyperglycemia among Chinese men and women in Mainland China. Asia Pac J Clin Nutr. 2010;19:586-93.

Zaher ZM, Zambari R, Pheng CS, Muruga V, Ng B, Appannah G, et al. Optimal cut-off levels to define obesity: Body mass index and waist circumference, and their relationship to cardiovascular disease, dyslipidaemia, hypertension and diabetes in Malaysia. Asia Pac J Clin Nutr. 2009;18:209-16.

Hubert HB, Feinleib M, McNamara M, Castelli W. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham heart study. Circulation. 1983;67:968-76.

Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Weath CW. Body-mass index and mortality in a prospective cohort of U.S. adults. New Engl J Med. 1999;341:1097-105.

Ashwell M, Gibson S. Waist-to-height ratio as an indicator of “early health risk”: simpler and more predictive than using a “matrix” based on BMI and waist circumference. BMJ Open. 2016;6:e010159.

Deurenberg-Yap M, Chew SK, Deurenberg P. Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians. Obes Rev. 2002;3:209-15.

World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization; (Technical Report Series, 894), 2000. Available at: https://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/.